BOSTON — More than 70 percent of the registered nurses of Tufts Medical Center cast a decisive vote tonight to authorize their union leadership to call a one-day strike if Tufts management continues to refuse to agree to desperately needed improvements in patient care conditions at this major Boston teaching hospital.

“With this vote, Tufts nurses are sending a strong message that they are ready and willing to take a stand for their patients and their profession,” said Barbara Tiller, RN, chair of the Massachusetts Nurses Association local bargaining unit at Tufts Medical Center, which represents more than 1,100 nurses at the hospital. “Nurses are united in their belief that the current staffing plan at the hospital is unsafe for patients and it needs to change. We can only hope that the hospital is listening and will finally work with us to address this patient safety crisis.”

The strike authorization vote comes as the parties prepare to meet tomorrow with a federal mediator, the next to last scheduled session before the expiration of the nurses’ union contract. While the nurses are hoping to reach an agreement to protect patients at the hospital, management has drawn a line in the sand, stating repeatedly that they have no interest in agreeing to enforceable limits on nurses’ patient assignments.

The vote does not mean the nurses will strike immediately. It gives the negotiating committee the authorization to call a one-day strike if and when they feel it is necessary. Once the committee issues its official notice to strike, the hospital will then have 10 days before the nurses will go out on strike.

The nurses have serious concerns about recent changes in RN staffing levels and other changes in how they deliver care that has resulted in nurses being forced to care for more patients at one time on nearly every unit. To compensate for chronic understaffing, TMC is using mandatory overtime, and is forcing nurses to “float” from one area of the hospital to another where they might not be competent to provide appropriate care.

“Those changes transformed this hospital from being one of the best staffed hospitals in Boston to the worst staffed hospital in the city,” Tiller explained. “As a result, our nurses spend less time with patients than nurses at other hospitals in the city. No other institution in the city is operating ICUs, including neonatal intensive care units, where their nurses are expected to care for three patients, nor are they expecting their medical surgical nurses to carry assignments of up to seven patients on a regular basis.” Tiller added that staffing changes have caused a dramatic deterioration in both the quality of care nurses are delivering and, in some cases, has resulted in serious lapses in care. In the past 15 months alone, nurses have filed more than 600 reports of incidents that jeopardized patient care. In addition, more than 80 percent of the nurses have signed petitions calling for safe staffing levels.

“I see nurses all over the hospital going home late and in tears over how bad their shift was, and hear that they spend sleepless nights wondering what they missed, or feeling horrible about not being able to provide the level of care they know their patients deserve. Even one of these occurrences is unacceptable, but to have it happening nearly every day is disgraceful, and it is patently dangerous,” Tiller added. “Issues that are occurring from larger patient assignments include delays in nursing assessment, delayed administration of medications and tests, nurses missing significant changes in patients’ health status, poor patient outcomes, patients falling due to lack of assistance in getting up and moving and patients being left in soiled beds for hours at a time.”

The MNA points to a significant body of research demonstrating the link between poor staffing and the use of forced overtime to a variety of poor patient outcomes and an increase in preventable patient deaths in the nation’s hospitals.

For example, a study in the Journal of the American Medical Association found that every patient above four assigned to a registered nurse resulted in a 7 percent increase in the risk of death for all patients under that nurses care. So when a Tufts nurse complains about having seven patients at one time, the science demonstrates that all of those patients are at a 21% greater risk of death. Additionally these same studies demonstrate that when nurses have fewer patients, there are significantly fewer complications, patient satisfaction increases, and nurse retention improves, with no negative impact on hospitals’ financial performance.

Other studies have found that nurses working mandatory overtime are three times more likely to make a medication error, and a brand new study released this month found that nurses working more than 12 hours results in an increase in patient deaths in hospitals. The Institute of Medicine has recommended that no nurse ever be required to work more than 12 hours, which is a regular occurrence at Tufts Medical Center.

The 1,100 RNs at TMC, who are currently in negotiations for a new contract, are seeking contractually guaranteed, safe staffing levels. At Tufts, management has not only increased nurses’ workload, but they have also refused to adjust staffing based on the acuity of patients (acuity is a term referring to the patient’s level of illness). In addition to calling for improved staffing levels, the nurses are also seeking a provision that would create a process to measure the acuity of patients on each unit and each shift, so that staffing could be further adjusted to meet the actual needs of patients.

The nurses are also calling for prohibitions against forced overtime and the inappropriate floating of nurses — all of which are needed to ensure that patients at Tufts Medical Center receive the safe care they deserve.

The nurses began negotiating a new contract with Tufts Medical Center management in September of 2010 and a total of 15 negotiating sessions have been held to date. The current contract expired on Dec. 31, 2010, and it has been extended by agreement of both parties through April 11.

“We sincerely hope the hospital will finally come to the table determined to resolve these issues,” Tiller explained. “For our part, we are determined to do whatever it takes to protect our patients because they are the ones who have the most to lose if conditions don’t improve. For our patients, this is truly a matter of life and death.”

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Founded in 1903, the Massachusetts Nurses Association is the largest professional health care organization and the largest union of registered nurses in the Commonwealth of Massachusetts. Its 23,000 members advance the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Legislature and regulatory agencies on health care issues affecting nurses and the public. The MNA is also a founding member of National Nurses United, the largest national nurses union in the United States with more than 150,000 members from coast to coast.